Machi Suka

Relationship between health literacy, health information access, health behavior, and health status in Japanese people

OBJECTIVE To examine the relationship between health literacy (HL), health information access, health behavior, and health status in Japanese people. METHODS A questionnaire survey was conducted at six healthcare facilities in Japan. Eligible respondents aged 20-64 years (n=1218) were included. Path analysis with structural equation modeling was performed to test the hypothesis model linking HL to health information access, health behavior, and health status. RESULTS The acceptable fitting model indicated that the pathways linking HL to health status consisted of two indirect paths; one intermediated by health information access and another intermediated by health behavior. Those with higher HL as measured by the 14-item Health Literacy Scale (HLS-14) were significantly more likely to get sufficient health information from multiple sources, less likely to have risky habits of smoking, regular drinking, and lack of exercise, and in turn, more likely to report good self-rated health. CONCLUSION HL was significantly associated with health information access and health behavior in Japanese people. HL may play a key role in health promotion, even in highly educated countries like Japan. PRACTICE IMPLICATIONS In order to enhance the effects of health promotion interventions, health professionals should aim at raising HL levels of their target population groups.

Development of Coronary Heart Disease Database

We developed the Coronary Heart Disease Database for the purpose of evaluating prognostic systems. The database consists of four training data-sets and one testing dataset, each of which includes more than ten thousand records related to the development of coronary heart disease.

The combined effect of visit-to-visit variability in HbA1c and systolic blood pressure on the incidence of cardiovascular events in patients with type 2 diabetes

Objective To investigate the association between long-term visit-to-visit variability in glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) and the incidence of cardiovascular disease (CVD) in patients with type 2 diabetes. Methods We retrospectively enrolled 632 patients with type 2 diabetes and no history of CVD who first visited our hospital between 1995 and 1996, were followed-up for ≥1 year, attended at least 4 clinic visits and had at least 1 visit per year. Patients were followed until June 2012 at the latest, and mailed questionnaires. Results During the median follow-up period (15.4 years), 81 patients developed CVD. Multivariate analysis revealed that the coefficient of variation (CV) and the variation independent of mean (VIM) for HbA1c and SBP were significant predictors of CVD incidence independent of mean HbA1c and SBP. Patients were classified into 4 groups by median HbA1cCV and SBPCV values and by median HbA1cVIM and SBPVIM values. Among these groups, the HRs were highest in the high-HbA1cCV/high-SBPCV and high-HbA1cVIM/high-SBPVIM groups and were significantly higher compared with those in the low-HbA1cCV/low-SBPCV and low-HbA1cVIM/low-SBPVIM groups, respectively. Among patients with mean SBP≥130 mm Hg, the HRs associated with HbA1cCV and HbA1cVIM were drastically elevated compared with those with mean SBP<130 mm Hg (interaction p<0.05). Conclusions Long-term visit-to-visit variability in HbA1c and SBP represented a combined and additive risk for CVD incidence in patients with type 2 diabetes. It is suggested that a synergistic effect exists between HbA1c variability and mean SBP levels for CVD incidence.

Validity and Reliability of the Japanese Version of the Newest Vital Sign: A Preliminary Study

Health literacy (HL) refers to the ability to obtain, process, and understand basic health information and services, and is thus needed to make appropriate health decisions. The Newest Vital Sign (NVS) is comprised of 6 questions about an ice cream nutrition label and assesses HL numeracy skills. We developed a Japanese version of the NVS (NVS-J) and evaluated the validity and reliability of the NVS-J in patients with chronic pain. The translation of the original NVS into Japanese was achieved as per the published guidelines. An observational study was subsequently performed to evaluate the validity and reliability of the NVS-J in 43 Japanese patients suffering from chronic pain. Factor analysis with promax rotation, using the Kaiser criterion (eigenvalues ≥1.0), and a scree plot revealed that the main component of the NVS-J consists of three determinative factors, and each factor consists of two NVS-J items. The criterion-related validity of the total NVS-J score was significantly correlated with the total score of Ishikawa et al.s self-rated HL Questionnaire, the clinical global assessment of comprehensive HL level, cognitive function, and the Brinkman index. In addition, Cronbachs coefficient for the total score of the NVS-J was adequate (alpha = 0.72). This study demonstrated that the NVS-J has good validity and reliability. Further, the NVS-J consists of three determinative factors: “basic numeracy ability,” “complex numeracy ability,” and “serious-minded ability.” These three HL abilities comprise a 3-step hierarchical structure. Adequate HL should be promoted in chronic pain patients to enable coping, improve functioning, and increase activities of daily living (ADLs) and quality of life (QOL).

The National Burden of Musculoskeletal Pain in Japan: Projections to the Year 2055

ObjectivesTo project the national burdens of low back, hip, and knee pains in Japan from 2005 to 2055 in terms of quality adjusted life years (QALYs). MethodsThe age- and sex-specific prevalence rates of low back, hip, and knee pains in the questionnaire survey (3048 men and 1885 women) were multiplied by the corresponding age- and sex-specific Japanese population projections. The losses of QALYs associated with low back, hip, and knee pains were calculated as the projected numbers of men and women with pain at each site multiplied by the corresponding sex-specific mean differences of EQ-5D scores between those who reported pain at each site and those who reported no musculoskeletal pain in the questionnaire survey. ResultsAmong a total of 87.9 million Japanese people aged 30 years or older in 2005, 21.4 million (24.3%), 3.2 million (3.7%), and 9.1 million (10.4%) were estimated to have low back, hip, and knee pains, respectively. The prevalence rates of low back, hip, and knee pains will gradually increase in subsequent years, reaching 26.5%, 4.4%, and 12.9%, respectively by 2055. Consequently, the losses of QALYs associated with low back, hip, and knee pains per 1000 population will increase from 17.2, 3.8, and 8.9, respectively in 2005 to 18.8, 4.5, and 11.2, respectively by 2055. DiscussionDue to population aging, the national burden of musculoskeletal pain in Japan is projected to increase in the next 50 years. Musculoskeletal pain has not been counted among national healthcare priorities. However, the control of musculoskeletal pain should not be bypassed to improve QOL and extend healthy life expectancy.

Patients views and experiences in online reporting adverse drug reactions: Findings of a national pilot study in Japan

Background Patients have been allowed to report adverse drug reactions (ADRs) directly to the government in some countries, which would contribute to pharmacovigilance. Objective We started a pilot study to determine whether web-based patient ADR reporting would work in Japan. This article aims to describe the characteristics of the patient reporters, and to clarify patient views and experiences of reporting. Methods Patients who submitted online ADR reports were contacted to respond to an ADR reporting questionnaire; only consenting reporters were included. Subjects with multiple responses were excluded from analysis. The questionnaire consisted of both closed and open questions. Questionnaire responses were examined using Pearson’s chi-squared test. Results A total of 220 web-based ADR reports were collected from January to December 2011; questionnaires were sent to 190 reporters, excluding those who gave multiple reports and those that refused to be contacted. Responses were obtained from 94 individuals (effective response rate: 49.5%). The median respondent age was 46.0 years. Sixty-three respondents found out about this pilot study on the Internet (67.0%). The numbers of respondents claiming that they had difficulty recalling the time/date of ADR occurrence were 16 patient reporters and three non-patient reporters. The number of reporters who found it difficult to complete the online reporting form was 22 patients (26.2%) and one non-patient (10%). Fifty-seven respondents (60.6%) expected feedback after reporting and many respondents wanted to know the process of ADR data collection and related information. Seventy-three respondents (77.7%) stated that they would report ADRs again in future. Conclusion Throughout the entire questionnaire, online patient ADR reporting was received with a forward-looking, positive approach. To facilitate smoother web-based reporting experiences in future, some improvements may be required in online ADR reporting forms, particularly with regard to respondent feedback.

Comprehensive assessment of the prognosis of pancreatic cancer: peripheral blood neutrophil–lymphocyte ratio and immunohistochemical analyses of the tumour site

Abstract Objective Several studies have suggested that an elevated neutrophil–lymphocyte ratio (NLR) is associated with a poorer prognosis in patients with pancreatic cancer (PC). The correlations between the NLR and immunohistochemical (IHC) analysis with regard to the prognosis of patients with PC remain to be elucidated. By using IHC findings, we determined the value of the NLR as a prognostic factor in patients with PC. Material and methods We collected the clinico-pathological data of 28 consecutive patients who underwent surgical resection for PC between January 2008 and December 2012 at The Jikei University Kashiwa Hospital. We investigated whether the NLR and IHC results were related and ensured the consistency of the prognosis of patients with PC. Results The Kaplan–Meier curves for the disease-free survival (DFS) and the overall survival (OS) revealed that an NLR ≥ 5 is an implicit factor for decreased DFS and OS in patients with PC (p = 0.003, p < 0.001, log-rank test). The density of CD163+ macrophages and CD66b+ neutrophils was significantly higher in the high NLR group; on the contrary, the density of CD20+ lymphocytes was significantly higher in the low NLR group. Moreover, a Mann–Whitney U test showed that the NLR was significantly correlated with a high density of CD20+ lymphocytes (p = 0.031) and CD163+ macrophages (p = 0.023), while the NLR was not significantly correlated with CD66b+ neutrophils (p = 0.397). Conclusions Our results demonstrated the validity of the NLR by IHC analyses and we determined that a higher value of NLR is a trustworthy prognostic factor for patients with PC.

Zinc-Excess Intake Causes the Deterioration of Renal Function Accompanied by an Elevation in Systemic Blood Pressure Primarily Through Superoxide Radical-Induced Oxidative Stress

Using rats fed 22 g/d of a control diet containing 0.005% zinc (Zn) or 2 Zn-excess diets containing 0.05% or 0.2% Zn for 4 weeks, we examined the mechanisms involved in the deterioration of renal function induced by Zn-excess intake. An increase in Zn intake elevated mean blood pressure (BP) and reduced renal blood flow (RBF) and inulin clearance in a dose-dependent manner. This decline in inulin clearance may be derived from a fall in RBF. Administration of the nitric oxide (NO) synthase inhibitor, Nω-nitro-l-arginine methyl ester, markedly increased mean BP and significantly decreased RBF in the 3 groups of rats. Administration of the exogenous superoxide radical (OO−) scavenger, tempol, significantly decreased mean BP and substantially increased RBF in all groups of rats. These observations suggest that both an elevation in systemic BP and a reduction in RBF seen in the 2 Zn-excess diet groups result from a decrease in the action of the vasodilator, NO, through the formation of peroxynitrite based on the nonenzymatic reaction of NO and increased OO−. Indeed, the activity of the endogenous OO− scavenger, copper/Zn-superoxide dismutase, was significantly reduced in the vessel wall of rats fed 2 Zn-excess diets versus a control diet. 8-Hydroxy-2′-deoxyguanosine formation caused by OO− generation was notably elevated in the kidneys of rats fed 2 Zn-excess diets relatively to rats fed a control diet. Thus, Zn-excess intake leads to the aggravation of renal function concomitantly with an increase in systemic BP predominantly through the oxidative stress caused by OO−.

Effect of Annual Health Checkups on Medical Expenditures in Japanese Middle-Aged Workers

Objective: To examine the effect of annual health checkups on medical expenditures in Japanese middle-aged workers. Methods: Medical expenditure data were accumulated from a health insurance society with 38 affiliated companies in Japan. Eligible employees (1811 men and 787 women) aged 40 to 55 years, who received medical care in 2002 (baseline year) and 2006 (4 years later) were surveyed about their participation in health checkups in 2003, 2004, and 2005. Results: After adjusting for medical care use in the baseline year, the 4-year total (2003–2006) of medical expenditures was significantly lower in those who had more frequent health checkups for both genders. The 4-year change (from 2002 to 2006) of medical expenditures was inversely associated with the frequency of health checkups, and this association was statistically significant for men. Conclusions: Annual health checkups may contribute to reduction of medical expenditures in Japanese middle-aged workers.

Relationship between individual characteristics, neighbourhood contexts and help-seeking intentions for mental illness

Objective Encouraging help-seeking for mental illness is essential for prevention of suicide. This study examined the relationship between individual characteristics, neighbourhood contexts and help-seeking intentions for mental illness for the purpose of elucidating the role of neighbourhood in the help-seeking process. Design, setting and participants A cross-sectional web-based survey was conducted among Japanese adults aged 20–59 years in June 2014. Eligible respondents who did not have a serious health condition were included in this study (n=3308). Main outcome measures Participants were asked how likely they would be to seek help from someone close to them (informal help) and medical professionals (formal help), respectively, if they were suffering from serious mental illness. Path analysis with structural equation modelling was performed to represent plausible connections between individual characteristics, neighbourhood contexts, and informal and formal help-seeking intentions. Results The acceptable fitting model indicated that those who had a tendency to consult about everyday affairs were significantly more likely to express an informal help-seeking intention that was directly associated with a formal help-seeking intention. Those living in a communicative neighbourhood, where neighbours say hello whenever they pass each other, were significantly more likely to express informal and formal help-seeking intentions. Those living in a supportive neighbourhood, where neighbours work together to solve neighbourhood problems, were significantly more likely to express an informal help-seeking intention. Adequate health literacy was directly associated with informal and formal help-seeking intentions, along with having an indirect effect on the formal help-seeking intention through developed positive perception of professional help. Conclusions The results of this study bear out the hypothesis that neighbourhood context contributes to help-seeking intentions for mental illness. Living in a neighbourhood with a communicative atmosphere and having adequate health literacy were acknowledged as possible facilitating factors for informal and formal help-seeking for mental illness.